| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,903 |
3,409 |
$315K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
3,696 |
2,934 |
$178K |
| D1120 |
Prophylaxis - child |
3,687 |
3,409 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,473 |
5,070 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
4,173 |
3,891 |
$71K |
| D1999 |
|
3,501 |
2,984 |
$65K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
445 |
303 |
$33K |
| D0330 |
Panoramic radiographic image |
803 |
756 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,657 |
1,558 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
217 |
205 |
$17K |
| D1110 |
Prophylaxis - adult |
487 |
435 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
164 |
$14K |
| D1351 |
Sealant - per tooth |
525 |
198 |
$11K |
| D1354 |
|
471 |
157 |
$10K |
| 99215 |
Prolong outpt/office vis |
84 |
79 |
$10K |
| 90688 |
|
540 |
508 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
465 |
439 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
372 |
309 |
$7K |
| 87428 |
|
166 |
147 |
$7K |
| 92015 |
Determination of refractive state |
844 |
798 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
275 |
$6K |
| 99173 |
|
1,419 |
1,224 |
$5K |
| 92551 |
|
1,328 |
1,148 |
$5K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
171 |
143 |
$5K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
81 |
69 |
$4K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
44 |
44 |
$3K |
| D0274 |
Bitewings - four radiographic images |
121 |
113 |
$2K |
| 87430 |
|
178 |
158 |
$2K |
| 94150 |
|
269 |
202 |
$2K |
| 96127 |
|
336 |
294 |
$1K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
142 |
129 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
129 |
94 |
$914.65 |
| 90620 |
|
38 |
37 |
$732.23 |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
75 |
42 |
$546.00 |
| 90621 |
|
29 |
26 |
$514.54 |
| 90686 |
|
15 |
15 |
$261.48 |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$261.00 |
| 90651 |
|
14 |
13 |
$257.27 |
| 36415 |
Collection of venous blood by venipuncture |
67 |
65 |
$104.00 |
| 90648 |
|
12 |
12 |
$96.00 |
| 36416 |
|
16 |
14 |
$26.00 |
| 94760 |
|
348 |
216 |
$0.00 |